Is there a connection between HIV and other sexually transmitted infections (STIs)?

Yes. Having an STI can increase a person's risk of becoming infected with HIV, whether the STI causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid), or does not cause breaks in the skin (e.g., Chlamydia, gonorrhea). If the STI infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STI causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.

In addition, if an HIV-infected person is also infected with another STI, that person is three to five times more likely than other HIV-infected persons (who don't have an STI) to transmit HIV through sexual contact. For those are sexually active, the following HIV prevention activities are highly effective:

• Engaging in sex that does not involve vaginal, anal, or oral sex;
• Having intercourse with only one uninfected partner; or
• Using latex or polyurethane condoms every time you have sex

What are the most common symptoms associated with STIs?

First of all, remember that some sexually transmitted diseases (STIs) cause no symptoms, and when symptoms do occur, they often go unrecognized. Most people with STIs have no symptoms—none! So you can be infected and even infect someone else without knowing it. However, there are some common signs to watch for. The symptoms listed below are tricky, as they can show up anywhere from two days to a couple of months after initial exposure to the disease. Sometimes symptoms can show up as much as several years after the initial STI infection.

If you have any of these symptoms or think you have been exposed to an STI, contact a healthcare provider immediately.

Take note of any:

• sores, bumps, or blisters near the mouth or genitals
• burning or pain during urination or a bowel movement
• flu-like symptoms including fever, chills, and aches
• swelling in the groin area

For women:

• unusual odor or discharge from the vagina
• pelvic pain
• burning or itching around the vagina
• unusual bleeding
• pain during intercourse
• increased severity of menstrual cramps or abnormal period

For men:

• discharge from the penis
• pain in the testicles

What is Chlamydia?

Bacteria that can infect the urethra (the opening of your penis), throat, anus or testicles.

How do I get it?
Oral, vaginal or anal sex without protection.

How can I tell?
After 7-14 days, there is a smelly discharge or burning, particularly when urinating, and itching or pain and swelling in the testicles.

How do I get rid of it?
Antibiotics.

How do I lower my risk?
Pay attention to any odors. Use condoms for anal and vaginal sex.

What is Genital Herpes?

A virus that causes sores on sex organ or mouth.

How do I get it?
Skin to skin contact even when there are no symptoms.

How can I tell?
After 5-21 days, there are small, painful sores that will go away. They may itch, burn, tingle or ooze. Sore reappear later.

How do I get rid of it?
No Cure. Treatments lessen symptoms and help prevent recurrence.

How do I lower my risk?
Pay attention to outbreaks and sores. Avoid contact as much as possible.

What is Genital Warts (HPV)?

A virus that infects the sex organs and causes warts or bumps, some very small.

How do I get it?
Contact with warts.

How can I tell?
After many months, small, painless bumps appear on the genitals or anal area.

How do I get rid of it?
No Cure. Warts are removed through different methods.

How do I lower my risk?
Pay attention to warts around someone’s penis/vagina, anus and genital area.

What is Gonorrhea?

Bacteria that can infect the urethra (opening of your penis), throat, anus or testicles.

How do I get it?
Oral, vaginal or anal sex without protection.

How can I tell?
After 3-5 days, there is a smelly discharge or burning, particularly when urinating.

How do I get rid of it?
Antibiotics.

How do I lower my risk?
Pay attention to any odors. Use condoms for anal and vaginal sex.

What is Hepatitis A?

A virus that causes inflammation of the liver.

How do I get it?
Orally transmitted. Sharing silverware or toothbrushes, eating contaminated food, or oral-to-anal contact with an infected person.

How can I tell?
After 10-50 days, there is fever, abdominal pain, nausea and fatigue.

How do I get rid of it?
No Cure. May take 6-12 months to resolve and is rarely fatal.

How do I lower my risk?
Get vaccinated. Use a latex barrier for anal and vaginal contact.

What is Hepatitis B?

A virus that causes inflammation of the liver. May lead to cancer or cirrhosis.

How do I get it?
Contact with infected blood or bodily fluids, unprotected anal sex or sharing needles with an infected person.

How can I tell?
After 60-90 days, fatigue, loss of appetite, nausea, yellowing of skin and eyes, dark urine.

How do I get rid of it?
No Cure. Liver infection can become chronic and sometimes be fatal.

How do I lower my risk?
Get vaccinated. Use a latex barrier for anal and vaginal contact.

What is Hepatitis C?

A virus that causes a more serious inflammation of the liver and liver failure over time.

How do I get it?
Contact with infected blood or bodily fluids, unprotected anal sex or sharing needles.

How can I tell?
After 60-90 days, fatigue, loss of appetite, nausea, but mostly no symptoms.

How do I get rid of it?
No Cure or vaccine. High chance of becoming chronic or fatal.

How do I lower my risk?
Don’t share needles. Use a condom for anal and vaginal sex.

What is HIV?

A virus that attacks the immune system.

How do I get it?
Unprotected anal and vaginal sex, sharing needles.

How can I tell?
Get an HIV test. During the first weeks: flu-like symptoms, fever, night sweats, weight loss, sore/swollen lymph nodes occur. After some years, people may develop illnesses, infections, and cancers (AIDS diagnosis).

How do I get rid of it?
No Cure or vaccine. HIV treatments help many people with HIV/AIDS to live longer and healthier lives.

How do I lower my risk?
Don’t share needles. Use a condom for anal and vaginal sex.

What is Lympho-granuloma venereum?

A bacterial infection that can cause ulcers on the penis or anus.

How do I get it?
Anal or oral sex – unprotected anal intercourse is a common risk factor.

How can I tell?
Within 30 days, pimple or blister turns into ulcer. Painful lymph nodes, anal discharge, bloody diarrhea.

How do I get rid of it?
Three weeks of uninterrupted antibiotics.

How do I lower my risk?
Use a condom for anal and vaginal sex. Pay attention to any open sores.

What is Syphilis?

A bacteria that causes a chancre sore on butt, penis or mouth. Untreated, it spreads throughout the body.

How do I get it?
Oral or anal sex without protection. Contact with sores.

How can I tell?
After 3 weeks, sores on genitals or mouth rash, swollen glands and fever.

How do I get rid of it?
Antibiotics.

How do I lower my risk?
Use a condom for anal and vaginal sex. Pay attention to any open sores.

Guide to Sexually Transmitted Infections (STI’s)

***It is important to always use a condom properly!***

For persons whose sexual behaviors place them at risk for HIV and STI's, correct and consistent use of a condom can reduce the risk of HIV and STI transmission. However, no protective method is 100% effective, and condom use cannot guarantee absolute protection against any STI's.

I'm HIV positive. Where can I get information about treatments?

The CDC recommends that you be in the care of a doctor or medical service, ideally one with experience treating people living with HIV. Your doctor can provide you with relevant information and guidance. You can also contact STAP for more information.

Can HIV-positive people become re-infected?

The short, simple answer is yes, because there are different strains of the virus. Therefore, it is possible for someone who's HIV positive to become infected with multiple and more virulent strains of HIV. This is one of the reasons that medical providers will encourage couples who are both HIV+ to still use condoms.

What is Post Exposure Prophylaxis (PEP)?

There are many ways to prevent HIV infection. Two of the most common are the use of condoms or dental dams, and not sharing needles when injecting drugs. Unfortunately, things don't always work out as planned. Accidents happen. Sometimes having unprotected sex wasn't a decision we made, but happened as a result of sexual assault. Other times we decide to have unprotected sex and then worry about it afterwards.

For these events, there is an option called PEP (Post Exposure Prophylaxis). PEP is the use of medications to reduce the chances of HIV infection after a person may have been exposed to the virus. A high-risk exposure includes unprotected anal or vaginal sex or needle exposure with someone who is HIV infected or someone of unknown status. Unprotected oral sex is lower risk for HIV infection. PEP is usually not given to people who had unprotected oral sex but you can talk to you doctor about whether it is right for you.

This therapy should NEVER be routine. It is a complicated medical therapy that should be attempted only in urgent situations.

Should I Take PEP?

If you are considering PEP, realize that potential benefits have to be weighed against the significant costs and health risks. You might be anxious about the experience that put you at risk for HIV. While some researchers believe PEP may help prevent HIV infection, this has not been proven and its use is currently being evaluated.

What are the possible side effects?

These medications can have severe side effects such as nausea, headaches, weight loss, dehydration and vomiting. Current recommendations for PEP treatments include a combination of a 2-3 antiretroviral therapy for a period of 28 days. The program requires a commitment to taking medications daily. The therapy may not be effective for everyone. If a person becomes infected with HIV, there is a risk that the virus will be difficult to treat because it may develop resistance to the PEP medications.

How do I get PEP?

If you have had a high-risk exposure within the past 72 hours, call your medical provider and ask to speak to a doctor about PEP. You can also visit the local emergency rooms. Each hospital emergency room has a protocol in place for PEP.

Please note that medication is best started as soon as possible, and no later than 72 hours after an exposure from unprotected anal or vaginal sex or from sharing needles.

How effective are latex condoms in preventing HIV?

Studies have shown that latex condoms are highly effective in preventing HIV transmission when used consistently and correctly. These studies looked at uninfected people considered to be at very high risk of infection because they were involved in sexual relationships with HIV-infected people. The studies found that even with repeated sexual contact, 98-100% of those people who used latex condoms correctly and consistently did not become infected with HIV.

I'm allergic to latex (and/or my partner is). What brands of polyurethane condoms are available as an alternative?

There are currently several available brands of polyurethane condoms that can be used as alternatives to latex condoms.

• The Female Condom (f2): The first condom designed to be worn by women for vaginal sex: it's also easily used by men for anal sex. Made of soft polyurethane, this product actually offers more protection against pregnancy and disease because it covers more area and is compatible with water-, silicon-, and oil-based lubricants.

• Avanti Duron Condom: Avanti was the first polyurethane condom. It's strong, nonporous, and non-permeable to all viruses and protects against STIs including HIV. It's hypoallergenic and thinner than latex, so it can transmit more sensation and warm to the body's temperature unlike latex. It's safe to use with water-, silicon-, and oil-based lubricants. Because polyurethane isn't quite as elastic as latex, the Avanti is slightly larger than the average latex condom.
  
  **For the record, Consumer Reports and the FDA have both reported that the Avanti breaks more readily than a latex condom, and are recommending them exclusively for those with latex allergies.**

• Trojan Supra Condom: The Supra is made from a medical-grade, advanced material called Microsheer, it's ultra-thin, strong, and clear (almost invisible), and has no latex allergens. It's compatible with water-,silicon-, and oil-based lubricants, has no taste or smell, and can transmit body heat, unlike latex. Supras are also quite a bit larger than the average condom.

• LifeStyles Skyn condom: This condom is made from a technologically advanced material called Polyisoprene, which is thin, strong and clear, with no latex allergens. It is compatible with water-based and silicone-based lubricants. These are approximately the same size as a standard condom.

DO NOT use lambskin condoms; they do not prevent transmission of HIV.

Is it safe/safer to use two condoms (instead of one) at the same time?

This is sometimes referred to as "double bagging." It is better to use a single condom at a time. When a single condom is used properly, the resulting safety factor for prevention of HIV transmission increases dramatically. When two condoms are used, there is a much bigger chance of friction between the two latex barriers. Friction (heat) is a condom's worst/biggest enemy. Heat contact with latex will increase the chance of breakage. (Hot temperatures, humidity, and even ultraviolet light can contribute to the deterioration of latex condoms.)

Does the spermicide nonoxyl-9 (N-9) help prevent HIV infection?

No. Recent scientific studies have conclusively proven nonoxyl-9 ineffective in preventing HIV transmission. In fact, it actually appears to increase your chances of becoming infected with HIV. Given the risks and the lack of any preventive benefits, the use of nonoxyl-9 is no longer recommended as a preventive measure against HIV transmission/infection.

What kinds of lubricants should I use?

It is always safe to use water-based lubricants and silicone-based lubricants with latex condoms. The lubrication heightens the sexual experience and, if you put a few drops of lube inside the tip of the condom, you'll have better stimulation along with added safety.

It is NEVER safe to use oil-based lubricants (skin lotions, baby oil, Vaseline, Crisco, cold cream, or even whipped cream) with latex condoms because oil dramatically weakens latex and definitely increases the chances of condom failure/breakage. For example, mineral oil is a common ingredient in many lotions. According to the CDC, within as little as 60 seconds of exposure, a 90% decrease in latex strength will occur in a condom when using an oil based lubricant. To demonstrate this phenomenon, blow up a latex condom, place a dab of oil or lotion on it, and watch it explode. The moral of the story? Don’t use oil on latex!

Only polyurethane condoms can safely be used with oil-based lubricants, so if you must use an oil-based lubricant, please use only polyurethane condoms. Polyurethane condoms also work well with water-based and silicone-based lubricants.

How can I reduce my risk from getting HIV and other STIs?

The following practices can help reduce your risk of becoming infected with HIV or other STIs…

• Keep semen and blood (including blood from piercing, shaving, or menstruation) out of the mouth, anus, or vagina and away from other mucous membranes (like the eyes or nose) and any cuts/breaks in the skin.

• Use latex or polyurethane condoms for oral, anal and vaginal sex, and pull out of your partner before ejaculation for added safety.

• Use only water-based or silicone-based lubricants with latex condoms. Oil based lubes like Crisco, Vaseline, baby oil, hand creams, etc., can cause latex to break. If you must use oil-based lubricants, use polyurethane condoms since these are safe to use with oil.

• If you are barebacking (unprotected anal sex), the insertive partner (top) should pull out before ejaculating. Avoid douching or using an enema beforehand as this actually puts you at a higher risk for becoming infected with HIV. Douching may wash away helpful or ‘good’ bacteria in the mucous membrane lining your rectum as well as reducing your natural lubrication. This increases the friction during anal penetration, which can cause tears in the rectum and anus. It's also not good to douche after anal penetration since this could spread the virus around even more. Also, use lots of lube, to make sure that your anus and rectum are as thoroughly lubricated as possible, which also helps to avoid cuts and tears which make it easier for HIV to get into your body's blood stream.

• Use a condom during oral sex even if your partner does not ejaculate in your mouth. HIV from semen or pre-cum could enter the blood stream through cuts or sores in your mouth. If you don't like the taste of plain latex, try flavored condoms—they can turn oral sex into a whole new experience for both you and your partner.

• Use dental dams, latex squares, cut-open condoms, or saran wrap for mouth to anus contact (rimming) or performing oral sex on a woman.

• Use latex gloves or finger cots for fingering, especially if you have any cuts or sores on your hands.

• Don't brush or floss your teeth for at least an hour before kissing or performing oral sex. You can use a mouthwash, breath mint, or gum instead. This will keep the number of tears and cuts in your mouth to a minimum. Try not to eat abrasive foods (tortilla chips, French bread, pretzels, etc.) for the same reasons. You should also try to be aware of whether or not you have any cuts or sores in your mouth. In general, it's a good idea to maintain excellent oral hygiene to prevent the possibility of having any easy tears/cuts in your mouth.

• Avoid getting semen in your mouth; semen contains HIV. If you do get semen in your mouth, as the saying goes: ‘Swallow or spit, just don’t let it sit.’ The longer semen stays in your mouth, the more potential for HIV to find an entry point into your body. Also, avoid deep-throating since this can cause abrasions in your throat. Precum and semen can come into contact with these abrasions, creating an effective entry point for HIV infection.

• Don't share sex toys. Use condoms on dildos or vibrators, and/or clean them with soap and water or in hydrogen peroxide after use.

• Alcohol and other drugs can impair your judgment and put you at risk for HIV infection or, if you already have HIV, for transmitting it to others. Many people have trouble keeping to their commitments to safe/healthy sexual behaviors after getting high.

• Massage, hugging, masturbation (solo or with others), and other activities that don't let blood or semen into your bloodstream are always safe.

Can I get HIV from getting a tattoo or through body piercing?

A risk of HIV transmission does exist if instruments contaminated with blood are not sterilized or disinfected, or if they are shared inappropriately between clients.

CDC recommends that instruments that are intended to penetrate the skin be used once, then disposed of or thoroughly cleaned and sterilized.

Personal service workers who do tattooing or body piercing should be educated about how HIV is transmitted and take precautions to prevent transmission of HIV and other blood-borne infections in their settings. If you are considering getting a tattoo or having your body pierced, ask staff at the establishment what procedures they use to prevent the spread of HIV and other blood-borne infections, such as hepatitis B virus.

You also may call the local health department to find out what sterilization procedures are in place in the local area for these types of establishments.

What does HIV and AIDS stand for?

HIV stands for Human Immunodeficiency Virus. It is a virus that attacks the human body’s immune system (the system that fights infections and invaders). Over time, people become less able to fight off illness, experience immunodeficiency, and may acquire an opportunistic infection.

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a condition that results from the weakening of the immune system over time. The disease progression from HIV to AIDS is different in each person, but certain criteria meet the medical definitions for AIDS. These symptoms and conditions are identified by the U.S. Centers for Disease Control (CDC).

These conditions include: being HIV+ and having either a T-Cell (CD4) cell count lower than 200 and/or having had one or more opportunistic infections that are considered to be AIDS-defining illnesses. Some of the more common opportunistic infections can include: toxoplasmosis, Pneumocystis carinii pneumonia (PCP), Kaposi's sarcoma, Cytomegalovirus (CMV), and Mycobacterium avium

How is HIV transmitted?

HIV is spread by direct contact of infected body fluids (including: blood, semen, pre- cum, vaginal secretions, breast milk and anal-rectal fluids) into a point of entry on the body of the uninfected person.

This means that the HIV contained in one or more of these body fluids must get into the bloodstream by entering a break in the skin, a vein, or through the mucous linings (such as the vagina, rectum, penis, mouth, eyes, or nose).

In the United States, the two most common ways for someone to acquire HIV is through unprotected sex (anal, vaginal, and/or oral) and sharing injection equipment (syringes, cookers, cottons, water, etc.).

Other body fluids such as tears, saliva, urine, sweat and vomit do not pose a risk unless visible blood is present. Clinical fluids (spinal fluid, cerebral fluid, pulmonary fluid, etc.) can also transmit HIV, but most individuals do not come in contact with these fluids during their daily activities. These fluids are potentially a risk for healthcare workers or people who come in contact with medical equipment after use.

The three most common ways that HIV is transmitted in the world are:

• Unprotected Sex – That’s having anal, vaginal or oral sex without a condom or other barrier with an HIV infected person and/or

• Sharing Needles – That’s sharing intravenous (IV) or intramuscular (IM) syringes (points), water, cottons, cookers, and/or other equipment (works) with an HIV infected person

• Mother to Child – From HIV-infected woman to babies before or during birth, or through breast feeding

If I already have an STD, is my risk for HIV infection greater?

Yes. If you have a current STD, the risk of contracting HIV is higher when you come in contact with infected fluids. The CDC estimates that your risk for becoming infected with HIV is 2 to 5 times greater if you already have an STD.

This is because of two important factors. The first is that more white blood cells will be in an area where infection is present (since they are trying to fight off the infection), thus making it easier for HIV to find a white blood cell carrier. The second is that when white blood cells are fighting infections, they cannot defend themselves. So, HIV can more easily target and enter a white blood cell that is busy working hard for your immune system.

Can I get HIV from casual contact?

NO! Shaking hands, hugging, using a toilet, drinking from the same glass, or the sneezing and coughing of an infected person will not put you at risk for HIV.

You can only get HIV from “intimate” contact with specific body fluids (including: blood, semen, pre-cum, vaginal secretions, breast milk and anal-rectal fluids) from an infected person.

You can't get HIV from day-to-day contact in the workplace, schools, or social settings, and you can't get HIV from shaking hands, hugging, or a casual kiss. You also can't get infected from a toilet seat, a drinking fountain, a doorknob, dishes, drinking glasses, food, or pets.

HIV is not an airborne or food-borne virus. HIV is a comparatively fragile virus. It does not like long outside the body, dies after being exposed to the air for only a few seconds, and cannot live in dried fluids on surfaces.

Is there a cure for HIV or AIDS?

No. There is no cure or vaccine for HIV infection or AIDS. Research scientists in the United States and other countries are actively working towards the development of a cure. However there are many treatments and medications to help treat HIV, and treatment options today are often a one pill daily regimen.

Can I tell if someone is HIV positive just from looking at them?

No, you can’t. Many of the typical outward symptoms of HIV are not clear indicators. Someone might look perfectly health and have HIV/AIDS or look ill for another reason. The only way to know if you have HIV is to get a test done outside the window period.

The only sure way to find out if someone else has HIV is to ask if they knows their HIV status and hope that they answer honestly. And if they don’t know their status, it's probably a good idea to assume you want to play safely, just in case!

Can I get HIV from anal sex?

Yes, you can get HIV from anal sex. Unprotected anal sex is the riskiest type of sex for the transmission of HIV. HIV can be spread to either sex partner during anal sex. Being the receptive partner is usually greater risk, but the insertive partner has risk as well. HIV can be found in the blood, semen, pre-cum, or vaginal fluid of a person infected with the virus.

In general, the person being penetrated or receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, the person doing the penetrating (or inserting his penis into an infected partner) is also at risk because HIV can enter through the urethra (the pee-hole or opening at the tip of the penis) or through small cuts, abrasions, or open sores on the penis.

If you're going to have anal sex, you can reduce the risk of HIV transmission significantly by using a latex or polyurethane condom. Most of the time, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. So, you should also be sure to use a water-based lubricant (rather than an oil-based lube) with your condom, to reduce the chances of the condom breaking.

If you are bare-backing, have the insertive partner (top) pull out before ejaculating. Avoid douching (enema) beforehand as this actually puts you at a higher risk for becoming infected with HIV. Douching may wash away helpful or ‘good’ bacteria in your mucous membrane lining inside. It will also reduce your natural lubrication, which increases the friction of being penetrated, and can cause tears in the rectum. So, use lots of lube! This ensures that your anus and rectum are as thoroughly lubricated as possible, which helps to avoid tears. Abrasions and cuts make it easier for HIV to get into your body's blood stream.

Can I get HIV from having vaginal sex?

Yes, it is possible for you to become infected with HIV through vaginal intercourse. In fact, it is the most common way the virus is transmitted in much of the world. Although vaginal sex is less risky than anal sex, unprotected vaginal sex is still considered to be a high risk activity for HIV infection.

Direct absorption of HIV through the mucous membranes that line the vagina is possible. The lining of the vagina can also get small tears during sex, and this allows HIV to enter the body more easily. The virus can be found in the blood, semen, pre- cum, or vaginal fluid of a person infected with the virus.

Women are more likely to contract HIV from an infected male partner from vaginal sex. However, HIV can also enter the body of the male through his urethra (the piss- slit or opening at the tip of the penis), or through small cuts or open sores on the penis. The risk for HIV infection also increases if you or your partner has a Sexually Transmitted Disease (STD).

If you choose to have vaginal intercourse, a latex male condom or the female condom will help protect you and your partner from the risk of HIV and other STDs. Studies have shown that latex condoms are very effective, though not perfect, in preventing HIV transmission, when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.

Can I get HIV from performing oral sex?

Yes, it is possible for you to become infected with HIV through performing oral sex, but most types of oral sex are considered low to very low risk. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is much less than either unprotected anal or vaginal sex. Blood, semen, pre-cum, and vaginal fluids all may contain the virus. HIV can penetrate cells in the mucous lining of the mouth, which can then carry HIV into the lymph nodes or the bloodstream.

The risk increases if:

• You have cuts or sores around or in your mouth or throat
• Your partner ejaculates in your mouth
• Your partner has another Sexually Transmitted Disease (STD)
• There is also blood present in the infected sexual fluids
  

Can I get HIV from someone performing oral sex on me?

In most cases, receiving oral sex is a low to no risk activity. While it is theoretically possible for you to become infected with HIV through receiving oral sex, it is very low risk. In the unlikely event that blood from your partner’s mouth, enters the urethra (the opening at the tip of the penis), the vagina, the anus, or directly into the body through small cuts or open sores, then there is a risk of HIV infection.

If you choose to have oral sex, and your partner is male:

Use a latex condom (some come in flavors!) on the penis; or use a polyurethane condom if you or your partner is allergic to latex. You can also use a water-based flavored lube in combination with almost any condom.

If you aren’t going to use a condom, you can reduce your risk of HIV infection by avoiding deep throating. Deep throating makes it easier for the slit of your penis to come into contact with the mucous membranes at the back of your partner’s throat, providing a good entry point for HIV to get into the body's blood stream.

Have your partner ejaculate (cum) outside of your mouth; or quickly move the cum out of your mouth. It appears that spitting or swallowing are of equivalent risk.

If you choose to have oral sex, and your partner is female:

Use a latex barrier (such as a dental dam or a cut-open condom) between your mouth and the vagina. Plastic food wrap also can be used as a barrier, in the event that you do not have access to a latex barrier device. Using a barrier will reduce the risk of blood or vaginal fluids entering your mouth.

Try to minimize oral sex during her menstrual cycle, as the presence of blood increases risk for HIV infection.

If you aren’t going to use a condom for oral sex condom, the following are ways to reduce the risk of HIV transmission.

• Don't brush or floss your teeth for at least an hour before performing oral sex. You can use a mouthwash, breath mint, or gum instead. This will keep the number of tears and cuts in your mouth to a minimum.

• Try not to eat abrasive foods (like tortilla chips, pretzels, etc.) for the same reasons.

• In general, it's also a good idea to maintain oral hygiene, thus promoting good gum health, and preventing the possibility of easy tears and cuts in the mouth.

• Avoid getting semen in your mouth; semen contains active HIV. If you do get semen in your mouth, the saying goes: ‘Swallow or spit, just don’t let it sit.’ The longer semen is in your mouth, the more potential for HIV to find an entry point into your body.

• Avoid deep throating since this can cause abrasions in the throat. Pre-cum and semen can come into contact with these abrasions, which can also create a more effective entry point for HIV infection.

If someone is HIV positive, but has an undetectable viral load, is it ‘safe’ to perform oral sex without a condom?

If a person with HIV has a consistently undetectable viral load, the chance of them transmitting to a partner through unprotected sexual contact is very small. This can lower the risk of transmission more than 95%, by many estimates. In addition, since oral sex is lower risk than intercourse, it is less likely that oral sex will result in HIV infection.

Nonetheless, there is still a small possibility that performing unprotected oral sex on a person with HIV could lead to infection. The viral load is only a measure of the HIV levels in a blood sample, but not within sexual fluids. There is no sure way to know or average how much HIV virus there is in semen or pre-cum, since it varies from man to man, and it is not routinely tested for viral concentration.

Can I get HIV from kissing on the cheek, open-mouth or deep kissing (‘swapping saliva’)?

HIV is not casually transmitted, so kissing on the cheek is completely safe. Even if the other person has the virus, your unbroken skin acts as a good barrier. (Remember, HIV has to have a point of entry to enter the body.) No one has become infected from such ordinary social contact as dry kisses, hugs, and handshakes.

Deep open-mouthed kissing is considered a very low-risk activity for the transmission of HIV. Transmission through kissing alone, although extremely rare, is possible if there is blood exchanged. This would likely happen if the individuals had sores or bleeding gums. Saliva alone (without blood present) is not a transmissible fluid for HIV.

Research has shown the effectiveness of latex condoms used on the penis to prevent the transmission of HIV. Condoms are not risk-free, but they greatly reduce your risk of becoming HIV-infected if your partner has the virus.

There are also non-latex male condoms, usually made from polyurethane, if you or your partner have a latex sensitivity or allergy. The FC2 Female Condom is another non-latex alternative. It is made of synthetic rubber called nitrile.